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Hyperbaric Oxygen Therapy Supports One Woman’s Road to Recovery

June 21, 2011

Wound Care Treatment Promotes the Body’s Own Healing Powers

Last October, 27-year-old Risa Moreno, a psychology student at Cal State East Bay, was diagnosed with breast cancer. Because her mother and other close female relatives also had developed breast cancer, she chose to have a double mastectomy on December 7, followed by breast reconstruction using skin and other tissue from her lower abdomen.

The surgery went well, but a non-healing wound developed afterward at the skin- and tissue-extraction site on her abdomen. Multiple attempts to treat the wound were unsuccessful, and it finally grew by late January to about the size of her fist.

"Apparently, the wound developed because I didn’t have a good blood supply at the site on my abdomen," she says. "I needed to have the wound healed before I could start follow-up chemotherapy, so my doctor referred me for wound care treatments, including hyperbaric oxygen therapy."

Moreno’s doctor was plastic surgeon Prasad Kilaru, M.D., Medical Director of the Washington Center for Wound Healing & Hyperbaric Medicine. The 6-year-old center had just moved in January to its new facility at 39141 Civic Center Drive in Fremont, and introduced hyperbaric oxygen therapy (HBOT) in February.

"Hyperbaric oxygen therapy is a new tool in our ability to provide the best possible wound care when it is used in conjunction with other treatments," says Dr. Kilaru. "It can make a big difference in chronic wound patients who have a compromised blood supply."

"Hyperbaric" means "increased pressure," so in HBOT, the patient is enclosed inside a pressurized clear acrylic chamber, breathing 100 percent pure oxygen. The air pressure in the chamber is twice the normal atmospheric pressure at sea level. In addition, the air we normally breathe contains only 21 percent oxygen, as opposed to the 100 percent oxygen in the hyperbaric chamber.

 "The blood’s hemoglobin and plasma cells carry oxygen throughout the body," Dr. Kilaru explains. "The body’s tissues need an adequate supply of oxygen to function, and injured body tissues need even more oxygen to heal. Oxygen stimulates the immune system to kill bacteria and releases the body’s own ‘growth factors’ that promote healing. Oxygen also stimulates the development of new blood vessels into the wound area. The amount of oxygen the blood carries can be increased dramatically – up to 10 times as much – by using hyperbaric oxygen therapy."

The hyperbaric chamber has a comfortable bed along with a clear ceiling and sides to allow patients to see their surroundings in an attractive treatment room equipped with TVs and video players.

"Our hyperbaric oxygen therapy patients come in for about two hours, five days a week, for anywhere from four to ten weeks, depending on their diagnosis and the complexity of their wounds," says Chungmei Shih, R.N., Clinical Nurse Specialist. "Patients say that when they are in the chamber, it feels similar to scuba diving with the increase of air pressure. They may need to yawn to equalize the air pressure in their ears – much like when taking off or landing in an airplane – but no one has complained of it being uncomfortable. Many patients even drift off to sleep."

Dr. Kilaru notes that HBOT may be appropriate as an additional wound care treatment for patients with a variety of chronic wound conditions, such as:

- Diabetic ulcers (open sores that will not heal or keep returning) or other wounds caused by artery blockage, nerve damage or improper functioning of valves in the veins. These ulcers most commonly occur in the lower legs and feet, and diabetic ulcers are the most common foot injuries leading to amputation.

- Chronic Refractory Osteomyelitis (CRO) – a persistent infection of bone and bone marrow that can result from a chronic wound. CRO also may be "ischemic," meaning there is a decrease in the blood supply cause by constriction or obstruction of the blood vessels.

- Wounds resulting from complications of radiation therapy for cancer, including bone that has been damaged (osteoradionecrosis) or soft tissue injury, for instance to the bowel or bladder (soft tissue radionecrosis).

- Skin grafts or "flaps" (such as TRAM flaps used in breast reconstruction) that fail to heal well because of poor blood flow and lack of oxygenation. Skin grafts are transfers of tissue without a native blood supply, and they must redevelop a blood supply to survive. Flaps bring their blood supply with them, but that blood supply can be compromised by infections, blockages in the veins or arteries, or injuries to the affected area.

Although most of the HBOT patients seen at the Center for Wound Healing & Hyperbaric Medicine are over age 50, the treatment can be beneficial for much younger patients, too, as in the case of Ms. Moreno.

"I had never heard of hyperbaric oxygen therapy before going to the wound clinic," she notes. "They explained it to me in terms I could understand, and it just made good sense. The actual treatments were not uncomfortable. The pressure feels like you’re under water, and your ears ‘pop’ like you’re riding in a plane, but that’s about it. I brought in my own DVDs to watch while laying there during the two-hour treatments."

Ms. Moreno completed 30 HBOT treatments over six weeks and grew fond of the staff providing her care. "The team there is awesome, including the nurses and the Safety Officer, Paul Brown, who operates the equipment and always stays within view of patients who are in treatment," she says. "We called Paul the ‘dive master,’ because he had been a Navy diver and knew all about the effects of being in a pressurized environment through his scuba diving experience."

In addition to Dr. Kilaru, the Safety Officer and nurses who are specially trained in wound care, the "team" at the Center for Wound Healing & Hyperbaric Medicine includes a multidisciplinary group of physicians – vascular surgeons, infectious disease specialists, general surgeons and a podiatrist. They also work closely with patients’ other primary care and specialist physicians to provide exceptional continuity of care and positive outcomes.

As for the outcome of Ms. Moreno’s HBOT treatments, she attests: "It took about three weeks before I really noticed a difference in the wound, partly because I couldn’t see it well due to its location. The wound is completely healed now, and I was recently able to start my follow-up chemotherapy for the breast cancer. I should be done with everything in July.

"For people who might be considering hyperbaric oxygen therapy, I’d like to let them know it’s not as exotic or scary as you might think," she adds. "Just bring lots of DVDs to watch!"

Learn More Online

To learn more about the services provided at the Washington Center for Wound Healing and Hyperbaric Medicine, visit www.whhs.com/wound or call (888) 449-6863. The center is located at 39141 Civic Center Drive in Fremont and is the only facility in the Tri-City area to offer HBOT. It also is the only local facility that works in partnership with Diversified Clinical Services, the largest provider of wound care services in the country.

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